Trauma
Is having a trauma-informed practice a therapy modality? True or False?
False
Name an assessment tool for MDD/PDD (4 correct answers)
1. PHQ-9
2. BDI-II(Beck Depressin Inventory II)
3. C-SSRS(Columbia Suicide Severity Rating Scale)
4. BADS(Behavioral Activation for Depression Scale)
A 25-year-old client initiates therapy with complaints of chronic depression and lack of motivation. The client currently lives with his grandparents, does not have any money, and is attempting to finish graduate school. He discloses that his parents had a traumatic divorce several years ago and he fears he will become like his father, who had an emotional breakdown and abused his mother. The client currently has a girlfriend who lives in another state, and he says he feels alone without her. Which of the following actions should the therapist take to assess this client?
A. Gather family history, explore client’s strengths, identify coping mechanisms
B. Gather family history, determine somatic symptoms, identify familial coping patterns
C. Explore substance use, determine somatic symptoms, identify coping mechanisms
D. Explore substance use, explore client’s strengths, identify familial coping patterns
A. Gather family history, explore client’s strengths, identify coping mechanisms
GAD is maintained by what?
What is intolerance of uncertainty-
the inability to tolerate the not-knowing that is a normal feature of life, rather than by specific feared outcomes
and
Secondary beliefs about worry also maintain it: positive beliefs ('worrying keeps me prepared'; 'worrying shows I care') and negative beliefs ('I can't control my worrying'; 'my worry will make me go crazy').
Why would clients struggle using a standard CBT approach? (1 correct answer for points-4 possible answers)
Because standard CBT assumes:
(a) The client can sustain attention on in-session content for 50 minutes.
(b) Homework is motivating, and the client will initiate it;
(c) The client will remember the session content and apply it during the week.
(d) The written thought records and worksheets are accessible
What tools/questionnaires can help you assess for trauma for all client intakes (not just clients coming for trauma)?
What is ACES scale (Adverse Childhood Experiences) and Life Events Checklist (LEC-5)
What differentials should you make at intake for MDD?
What is...
Bipolar II (screen with HCL-32 for hypomania, do this with every depressed client);
vs
Persistent Depressive Disorder (2+ year subthreshold course with baseline dysthymia);
vs
PTSD (trauma-linked onset, PCL-5);
vs
ADHD (lifelong EF(excutive functioning) impairment preceding mood onset);
vs
medical causes;
vs
substance-induced depression
A 36-year-old client initiates therapy and reports that the previous night she went on a date with a man she had met online. After dinner he raped her and then dropped her off at home as if nothing happened. She tells the therapist that she spent the night in the emergency room, and is afraid to go home because her assaulter knows where she lives. Which of the following actions should the therapist initially take in this crisis situation?
A. Re-establish the client’s feelings of control to reduce her sense of victimization
B. Evaluate the client’s support systems to identify a safe place for the client to stay
C. Develop the client’s trauma narrative of the event to desensitize emotional impact
D. Encourage the client to file a police report to protect other women from the perpetrator
B. Evaluate the client’s support systems to identify a safe place for the client to stay
What scales can be used to assess for GAD?
What is
1. GAD-7(can be adminisitered every session)
2. PSWQ (Penn State Worry Questionnaire)
3. IUS-12 (Intolerance of Uncertainty Scale)
What DBT skills would support a client with ADHD in improving their emotional dysregulation?
What are Opposite Action and TIPP skills
(They help individuals shift their focus and emotional state when intense feelings interfere with functioning or cause "ADHD paralysis")
What does it mean to have a trauma-informed response as a clinician? (5 correct answers)
What is...
1. Building the therapeutic relationship with explicit attention to safety and predictability;
2. Not pressing for detail about traumatic events before the client is ready;
3. Not interpreting avoidance as resistance;
4. Not placing emphasis on behavioral compliance before establishing safety;
5. Recognizing that emotional reactivity in session may be a trauma response rather than a therapeutic challenge.
You administer the PHQ-9 for the 3rd time to a client with MDD. When the client completes the PHQ-9, you see that suicidality is indicated. What should you do next?
What is administering C-SSRS
A 7-year-old client is brought to therapy by his mother, who states that the client has been moody and defiant at home and has been fighting with other children at school. She states that the client’s change in behavior began four months ago, following a foreclosure of the house that the family had lived in for several years. She further states that the client’s father did not move with them to the new apartment, and that despite the fact that he works constantly, they still face eviction so she is refusing to let him see the client. Which of the following goals should be included in the treatment plan for this case?
A. Decrease fighting at school and defiance at home Re-establish appropriate relationships between family members Refer the mother for financial assistance
B. Decrease fighting at school and defiance at home Re-establish appropriate relationships between family members Refer the mother for anger management
C. Enhance impulse-control and attention span Explore the marital relationship Refer the mother for financial assistance
D. Enhance impulse-control and attention span Explore the marital relationship Refer the mother for anger management
B. Decrease fighting at school and defiance at home Re-establish appropriate relationships between family members Refer the mother for anger management
What are the primary interventions for GAD? and How?
What is CBT
How to use CBT for GAD psychoeducation on the IU model; worry exposure (scheduled worry time + in-session imaginal scripts of worst-case scenarios without neutralization); cognitive restructuring targeting uncertainty appraisals; behavioral experiments to test the utility of worry; problem-orientation training (distinguishing solvable problems from unsolvable uncertainties).
What does sustained masking cause in a client diagnosed with ASD (adult)?
What would you look for?(5 answers-1 correct of the 5 for points)
What is Autistic Burnout
Presentation can be of profound exhaustion, loss of previously acquired skills, withdrawal, and inability to function in contexts where the client previously managed. Autistic burnout resembles severe depression and is often misdiagnosed as such.
What Dx is always accompanied with trauma?
What is Borderline Personality Disorder
This is the first-line treatment approach for MDD, which has similar effectiveness as CBT, and "can" complete treatment in 20 sessions.
What is Behavioral Activation (BA treats depression by increasing engagement in rewarding, value-aligned activities. It works by breaking the cycle of avoidance and withdrawal, prompting action—even without motivation—to improve mood. Techniques include activity scheduling, tracking, and identifying rewarding behaviors)
A 19-year-old college student is referred to therapy by her physician for symptoms of panic. Her physician declined to prescribe medication until the client has initiated therapy. The client, however, believes that only medication will control her symptoms and that therapy is a “waste of time.” Which of the following interventions would a cognitivebehavioral therapist use to address the client’s participation in therapy?
A. Interpret the client’s distorted cognitions and identify their connection to her current symptoms of panic
B. Explore the client’s disappointment with her physician and validate her automatic thoughts as a logical consequence
C. Examine the client’s assumptions regarding treatment and collaborate with her to promote a shift in personal conclusions
D. Role-play with the client to increase her assertiveness and encourage her to communicate her concerns directly with her physician
C. Examine the client’s assumptions regarding treatment and collaborate with her to promote a shift in personal conclusions
What are the first line medications for treating GAD?
What are SSRIs (Buspirone, Benzodiazepines (not for long-term treatment)
For a late-stage diagnosis of ASD for an adult, should the processing of the diagnosis only be for a short time? True or False
False
Complex trauma in childhood produces ADHD-like executive function deficits through different mechanisms than neurodevelopmental ADHD...such as poor focus, impulsivity, and emotional dysregulation—primarily involving survival-based adaptation rather than innate developmental differences
Why is providing support and validation without the behavioral component an error when treating MDD/PDD when using BA?
If every session is primarily emotionally supportive without a scheduled activity commitment, you are delivering supportive therapy.
A therapist is currently involved in a contentious divorce and perceives his spouse as aggressive and unreasonable. The therapist begins meeting weekly with a colleague for consultation to prevent his feelings from impacting therapy with his clients. Three weeks later, a client who has been in ongoing therapy for symptoms of depression begins describing relationship difficulties that are similar to what the therapist is experiencing. Which of the following actions should the therapist take to manage the ethical issues involved in this case?
A. Provide continued treatment to the client and discuss the case with the colleague to monitor own feelings
B. Utilize limited self-disclosure and reassure the client of the therapist’s understanding to enhance therapeutic empathy
C. Explain the potential for bias on the part of the therapist and refer the client to an alternate therapist to provide ongoing treatment
D. Contain the therapist’s own feelings and focus discussions on the client’s depression to maintain consistency with established treatment goals
A. Provide continued treatment to the client and discuss the case with the colleague to monitor own feelings
Why is worry exposure a critical technique for treating GAD?
Because it demonstrates to a client that worry is controllable (challenging the 'I can't control it' belief) and that uncertainty is tolerable without immediate resolution
Which two groups tend to engage more in camouflaging masking) ASD symptoms?